Food Sensitivities

Allergies, intolerances, and adverse food reactions explained.

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📖 The Story: When Food Becomes a Problem

For most people, food is nourishing and pleasurable. But for millions, certain foods trigger uncomfortable or even dangerous reactions—ranging from mild bloating to life-threatening anaphylaxis. The challenge is that food reactions exist on a complex spectrum, with different mechanisms, symptoms, and severities that are often confused or misdiagnosed.

Many people self-diagnose "food allergies" when they actually have intolerances or sensitivities. Others dismiss genuine reactions as psychosomatic. Some unnecessarily eliminate entire food groups based on unreliable tests, while others suffer for years without identifying the culprit. Understanding the distinctions between allergies, intolerances, and sensitivities—and knowing how to identify your specific triggers—is essential for both symptom relief and dietary freedom.

The key insight: not all adverse food reactions are created equal. A true IgE-mediated food allergy involves the immune system and can be life-threatening. A food intolerance (like lactose intolerance) involves the digestive system and is uncomfortable but not dangerous. Food sensitivities fall into a gray area—real symptoms, but mechanisms are less clear. Each requires different approaches for diagnosis and management.

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🚶 The Journey: How Food Reactions Develop

The Timeline of Food Sensitivity Development

First Exposure (Minutes to Days)

• For IgE allergies: Sensitization occurs—your immune system creates antibodies against a food protein
• No symptoms yet; the immune system is "learning" to recognize the food as a threat
• This can happen after one exposure or many

Subsequent Exposures (Varied Timeline)

IgE-Mediated Allergy (Minutes to 2 Hours)

• Food protein enters the body
• Within minutes: IgE antibodies recognize the protein and trigger mast cells
• Mast cells release histamine and other chemicals
• 5-30 minutes: Symptoms begin—tingling, hives, swelling
• Can progress to anaphylaxis within minutes to hours

Food Intolerance (30 Minutes to Hours)

• Food reaches small intestine
• Without sufficient enzyme (lactase, DAO, etc.), food component isn't broken down properly
• Undigested substance reaches colon (30 minutes to 2 hours)
• Bacterial fermentation begins, producing gas and drawing water
• 1-4 hours: Bloating, cramping, diarrhea develop
• Symptoms typically resolve within 24 hours

Food Sensitivity/NCGS (Hours to Days)

• Food consumed; exact mechanism unclear
• Several hours to 1-2 days: Symptoms gradually develop
• May involve innate immune activation, gut permeability changes, or chemical accumulation
• Symptoms can persist for days after exposure
• Pattern often harder to identify due to delayed timing

How Gut Health Influences Reactions

Healthy Gut:

• Strong intestinal barrier prevents protein fragments from entering bloodstream
• Sufficient enzyme production breaks down problematic compounds
• Balanced microbiome degrades food chemicals (histamine, oxalates)
• Immune system tolerates dietary proteins

Compromised Gut:

• Leaky gut allows larger protein fragments through—may trigger immune responses
• Reduced enzyme production increases intolerance symptoms
• Dysbiosis impairs chemical breakdown—histamine, oxalates accumulate
• Inflammation makes reactions more likely and severe

Recovery Timeline:

• Removing trigger foods: 2-6 weeks for symptoms to fully resolve
• Gut healing: 3-6 months with proper support
• Tolerance may increase: Some people regain ability to tolerate small amounts
• Secondary intolerances often resolve when underlying condition (SIBO, IBD) is treated

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🧠 The Science: Understanding Food Reactions

The Spectrum of Food Reactions

Allergy vs. Intolerance vs. Sensitivity

Feature	True Allergy	Intolerance	Sensitivity
Mechanism	IgE immune response	Enzyme deficiency or digestive issue	Unclear; possibly immune or chemical
Timing	Minutes to 2 hours	30 min to several hours	Hours to days
Severity	Mild to life-threatening	Uncomfortable, not dangerous	Variable, not life-threatening
Dose-dependent?	No—trace amounts can trigger	Yes—small amounts often OK	Often yes
Examples	Peanut, shellfish, milk allergy	Lactose, fructose malabsorption	NCGS, histamine, salicylates
Testing	Skin prick, IgE blood test	Breath tests, elimination	Elimination diet only
Treatment	Strict avoidance, epinephrine	Enzyme supplements, moderation	Identify and limit triggers

True Food Allergies (IgE-Mediated)

What it is: An immune system reaction where the body produces IgE antibodies against a specific food protein. Upon re-exposure, these antibodies trigger histamine release, causing rapid-onset symptoms.

Prevalence: ~5% of adults, ~8% of children (many outgrow childhood allergies)

The Big 9 Allergens (US):

1. Milk
2. Eggs
3. Fish
4. Shellfish
5. Tree nuts
6. Peanuts
7. Wheat
8. Soybeans
9. Sesame (added 2023)

Symptoms range from mild to severe:

Mild	Moderate	Severe (Anaphylaxis)
Hives, itching	Swelling of lips/face	Throat closing
Runny nose	Abdominal pain, vomiting	Difficulty breathing
Tingling mouth	Widespread hives	Drop in blood pressure
		Rapid pulse, dizziness
		Loss of consciousness

Anaphylaxis is a Medical Emergency

If someone shows signs of anaphylaxis (difficulty breathing, swelling, dizziness), use epinephrine (EpiPen) immediately and call emergency services. Anaphylaxis can be fatal within minutes.

Management:

• Strict avoidance of trigger food (even trace amounts)
• Carry epinephrine auto-injector at all times
• Read all labels (allergens hide in unexpected places)
• Inform restaurants about severity
• Wear medical alert bracelet

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🎯 Topics in This Section

This section covers all types of food reactions in detail:

Page	What It Covers
Common Intolerances	Lactose, fructose, and histamine intolerance—enzyme-based reactions
Gluten Sensitivity	Non-celiac gluten/wheat sensitivity, the fructan debate, diagnosis
Elimination Diets	The gold-standard protocol for identifying food triggers
Food Chemical Sensitivities	Salicylates, oxalates, amines, and the FAILSAFE approach

For celiac disease, see Digestive Issues.

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🧪 Testing: What Works and What Doesn't

Valid Tests

Evidence-Based Diagnostic Tools

Test	What It Detects	Accuracy	When to Use
Skin prick test	IgE-mediated allergies	High sensitivity	Screen for true allergies
Specific IgE blood test	IgE antibodies to specific foods	High specificity	Confirm allergies
Oral food challenge	Any adverse reaction	Gold standard	Definitive diagnosis (supervised)
Celiac serology (tTG-IgA)	Celiac disease antibodies	High accuracy	Screen for celiac
Endoscopy with biopsy	Intestinal damage	Gold standard	Confirm celiac
Hydrogen breath test	Lactose, fructose malabsorption	Good accuracy	Diagnose specific intolerances
Elimination diet	Any food reaction	Very accurate	When tests inconclusive

The elimination diet with systematic reintroduction remains the most accurate method for identifying intolerances and sensitivities. See Elimination Diets for the full protocol.

Questionable Tests

Tests with Limited or No Scientific Support

Test	Claim	Reality
IgG food sensitivity panels	Detects "sensitivities" via IgG antibodies	IgG indicates exposure, not sensitivity; unreliable
Hair analysis	Detects sensitivities/deficiencies	No scientific validity for food reactions
Applied kinesiology	Muscle testing identifies triggers	No scientific basis
Electrodermal testing (Vega)	Electrical resistance indicates reactions	No evidence of accuracy
Cytotoxic testing	Blood cell changes indicate reactions	Unreliable, not reproducible

Why IgG Testing is Problematic

"Food-specific IgG has not been demonstrated to have value in the diagnosis of food allergy or intolerance." — American Academy of Allergy, Asthma & Immunology

• IgG antibodies indicate exposure to a food, not intolerance
• Elevated IgG is normal after eating a food regularly
• May actually indicate tolerance, not sensitivity
• Leads to unnecessary dietary restrictions
• Not endorsed by AAAAI, EAACI, or any major allergy organization

Bottom line: Save your money. IgG tests cost $200-600 and provide misleading results. Use elimination diets instead.

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## 🎯 Practical Application

Implementing Food Sensitivity Management

Step 1: Identification

Start by determining what type of food reaction you're experiencing:

• Keep a detailed food and symptom diary for 2-4 weeks

  • Log everything you eat with timestamps
  • Rate symptom severity (1-10) across categories: GI, skin, respiratory, energy, headaches
  • Note timing between eating and symptom onset
  • Track contextual factors: stress levels, sleep quality, menstrual cycle, exercise

• Identify your reaction pattern:

  • Immediate (<30 min) + hives/swelling → Likely IgE allergy → See allergist immediately
  • 30 min-2 hours + bloating/gas → Likely intolerance (lactose, fructose)
  • 2-24 hours + varied symptoms → Sensitivity or delayed reaction
  • Inconsistent timing + multiple foods → Consider histamine intolerance

• Get appropriate testing BEFORE elimination:

  • If eating gluten with symptoms → Test for celiac disease first (tTG-IgA, total IgA)
  • If suspected true allergy → Skin prick test or specific IgE blood test
  • If dairy-related → Distinguish allergy (hives, breathing) from intolerance (bloating)
  • If lactose/fructose suspected → Consider hydrogen breath test
  • Avoid: IgG food sensitivity panels (not scientifically valid)

Step 2: Elimination

Remove suspected trigger foods systematically, not haphazardly:

• Targeted elimination (preferred for single suspected trigger):

  • Eliminate ONE suspected food or food group at a time
  • Remove it completely for 3-4 weeks minimum
  • Keep everything else in your diet the same
  • Track symptoms weekly—look for 50%+ improvement
  • Benefits: You'll know exactly what helped; less restrictive

• Comprehensive elimination (for complex cases):

  • Remove common triggers simultaneously: dairy, gluten, eggs, soy, corn, shellfish, tree nuts, peanuts
  • Duration: 4-6 weeks minimum for full symptom resolution
  • Work with registered dietitian to ensure nutritional adequacy
  • See Elimination Diets for detailed protocol
  • Benefits: Faster identification when multiple triggers suspected

• Histamine elimination (for multi-food reactivity):

  • Eat only fresh foods—no leftovers beyond 24 hours
  • Avoid: aged/fermented foods, cured meats, alcohol, canned fish, aged cheese
  • Freeze leftovers immediately after cooking
  • Duration: 2-4 weeks
  • Benefits: Addresses many seemingly unrelated food reactions

• During elimination:

  • Read all labels carefully (allergens hide in unexpected places)
  • Avoid cross-contamination in shared kitchens
  • Don't compensate by overeating other trigger foods
  • Continue symptom diary—quantify improvement
  • Be patient—some reactions take weeks to fully resolve

Step 3: Reintroduction

This step is ESSENTIAL—don't skip it. Reintroduction confirms your actual triggers:

• Why reintroduction matters:

  • Without it, you may unnecessarily restrict safe foods
  • Symptoms might have improved for other reasons (placebo, stress reduction, diet quality)
  • You need confirmation that the food actually causes your symptoms
  • Many people discover they tolerate more than expected

• Systematic reintroduction protocol:

  1. Choose one food to test (start with least-suspected)
  2. Eat a normal serving of that food alone (not mixed with other eliminated foods)
  3. Continue eating it for 2-3 consecutive days
  4. Track symptoms carefully—rate severity daily
  5. Wait 3-5 days between each food reintroduction (for delayed reactions to fully manifest)
  6. Compare to baseline: Did symptoms clearly return? How severe?

• Interpreting results:

  • Clear reaction (symptoms return) → Confirmed trigger; avoid for now
  • No reaction → Safe food; add back to your regular diet permanently
  • Mild/uncertain reaction → Test threshold (see Step 4)
  • Delayed reaction (2+ days) → May still be a trigger; retest after extending washout period

• For dose-dependent intolerances:

  • Start with small serving (¼ cup milk, 1 slice bread)
  • If tolerated, gradually increase serving size
  • Find your personal threshold
  • Example: "I can tolerate ½ cup dairy but not 1 cup"

Step 4: Long-term Management

Build a sustainable approach based on your confirmed triggers:

• Create your personalized food framework:

  • Safe foods list: Eat freely—no reactions observed
  • Threshold foods list: OK in specific amounts (document limits)
  • Avoid foods list: Confirmed triggers with clear, reproducible reactions
  • Situational strategies: "I can have aged cheese if I've slept well and stress is low"

• Optimize tolerance with support strategies:

  • Enzyme supplements: Lactase for lactose, DAO for histamine, alpha-galactosidase for beans
  • Timing: Eat threshold foods when gut is healthiest (well-rested, low stress)
  • Pairing: Combine fructose with glucose to improve absorption
  • Fresh preparation: For histamine sensitivity, eat within 24 hours of cooking
  • Rotation: Don't eat threshold foods daily—give your system breaks

• Address root causes (improves tolerance over time):

  • Gut healing: Leaky gut repair may reduce sensitivities (3-6 months)
  • SIBO/dysbiosis treatment: Rebalancing microbiome often resolves secondary intolerances
  • Stress management: Stress worsens food reactivity via gut-brain axis
  • Sleep optimization: Poor sleep increases gut permeability and immune reactivity
  • Anti-inflammatory diet: Reduces overall inflammatory load

• Regular reassessment (every 6-12 months):

  • Gut health changes over time—so can your tolerance
  • Retest previously reactive foods with small amounts
  • Some people regain tolerance, especially after gut healing
  • Don't assume lifelong restriction without retesting
  • Exception: True IgE allergies rarely resolve (but can be retested by allergist)

• When to get professional help:

  • Eliminating multiple major food groups (risk of nutritional deficiencies)
  • Child with food restrictions (growth and development concerns)
  • Pregnant/breastfeeding and planning eliminations
  • Weight loss or signs of malnutrition (anemia, fatigue, hair loss)
  • Developing anxiety around food (orthorexia risk)
  • Symptoms persist despite proper elimination
  • Need help creating balanced, varied meal plans
  • Work with: Registered dietitian (RD), allergist, gastroenterologist

• Maintain dietary freedom:

  • Goal is minimum necessary restriction, not maximum elimination
  • Quality of life matters—find your balance
  • Social eating is important—plan strategies for restaurants/events
  • Don't let food fear dominate your life
  • Perfection isn't required—occasional exposure to threshold foods may be acceptable

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👀 Signs & Signals

Reading Your Body's Food Reaction Signals

Signal	What It Means	What To Do
Immediate tingling/itching in mouth	Possible IgE allergy—early warning	Stop eating immediately; watch for progression
Hives within 30 minutes	Likely IgE-mediated allergy	Take antihistamine; monitor breathing; seek medical attention
Throat tightness or difficulty swallowing	Anaphylaxis developing	Use EpiPen if available; call 911 immediately
Bloating 1-2 hours after dairy	Likely lactose intolerance	Try lactose-free products or lactase enzyme
Gas & cramping after fruit/sweets	Possible fructose malabsorption	Reduce high-fructose fruits; pair with glucose
Multi-system symptoms (headache + hives + GI)	Possible histamine intolerance	Try low-histamine diet; eat fresh foods only
Symptoms 24-48 hours later	Delayed sensitivity (NCGS, food chemical)	Keep detailed food diary; use elimination diet
Reactions only with large amounts	Dose-dependent intolerance	Find your threshold; don't eliminate completely
Same food causes different reactions	Total load issue (histamine bucket)	Track cumulative intake; consider stress/hormones
Worsening symptoms over time	Possible underlying gut issue	See GI doctor; test for SIBO, IBD, celiac

Timing Patterns Guide

Timing	Most Likely Type	Next Steps
<5 minutes	IgE allergy (severe)	Medical emergency—use EpiPen, call 911
5-30 minutes	IgE allergy (mild-moderate)	Antihistamine; medical evaluation needed
30 min - 2 hours	Lactose or fructose intolerance	Try breath test or enzyme supplement
2-6 hours	Histamine or food chemical	Low-histamine trial; food diary
6-24 hours	NCGS, food sensitivity	Elimination diet with reintroduction
24-72 hours	Delayed sensitivity or autoimmune	Rule out celiac; consider broader elimination

Severity Indicators

Green Light (Uncomfortable but not dangerous):

• Bloating, gas, cramping
• Diarrhea or constipation
• Mild headache
• Skin flushing
• Action: Identify and avoid trigger; find threshold

Yellow Light (Concerning—seek medical advice):

• Persistent symptoms despite avoidance
• Unintentional weight loss
• Signs of malabsorption (anemia, vitamin deficiencies)
• Frequent reactions to many foods
• Action: See doctor; get proper testing

Red Light (Medical emergency):

• Difficulty breathing or wheezing
• Swelling of tongue, lips, or throat
• Rapid pulse with dizziness
• Loss of consciousness
• Severe abdominal pain with vomiting blood
• Action: EpiPen if available; call 911 immediately

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📸 What It Looks Like

Example 1: Lactose Intolerance Discovery

Before identification:

• Sarah, 32, has experienced bloating and diarrhea for years
• Symptoms worse after breakfast (cereal with milk) and evening ice cream
• Assumed it was "normal" or stress-related

Food diary excerpt (Week 1):

Day	Meal	Foods	Symptoms (2-3h later)
Mon	Breakfast	Greek yogurt (1 cup), berries, granola	Mild bloating (4/10)
Mon	Lunch	Grilled chicken salad, olive oil	None
Mon	Dinner	Pasta with cream sauce, parmesan	Severe bloating (8/10), diarrhea
Tue	Breakfast	Oatmeal with almond milk, banana	None
Tue	Dinner	Pizza (2 slices)	Moderate bloating (6/10), gas

Pattern identified: Dairy products, especially in larger amounts

Elimination trial (Week 2-3):

• Switched to lactose-free milk and dairy-free alternatives
• Kept hard aged cheese (low lactose)
• Symptoms reduced by 80%

Threshold found:

• Can tolerate: Hard cheese, small amounts of yogurt
• Cannot tolerate: Milk, ice cream, soft cheese in large amounts
• Solution: Lactase enzyme when eating higher-lactose foods

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Example 2: Histamine Intolerance Pattern

Jake, 28, unexplained symptoms:

• Migraines 2-3x/week
• Facial flushing after meals
• Nasal congestion
• Fatigue and brain fog
• Symptoms vary day-to-day

Food diary reveals pattern:

Trigger Foods (High Histamine)	Symptoms Within 1-4 Hours
Leftover chicken stir-fry (day 3)	Migraine + flushing
Aged cheddar sandwich	Nasal congestion + fatigue
Red wine with dinner	Severe flushing + headache
Fresh grilled salmon	No reaction
Canned tuna sandwich	Moderate headache

Low-histamine trial (Week 1-4):

• Only fresh foods—no leftovers past 24 hours
• Avoided: Aged cheese, cured meats, alcohol, fermented foods
• Fresh proteins cooked and eaten immediately or frozen
• 70% symptom improvement

Maintenance approach:

• Freeze leftovers immediately
• Fresh fish only (never canned)
• Limit aged cheeses to special occasions
• No alcohol during high-stress weeks (bucket fuller)
• DAO supplement before unavoidable high-histamine meals

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Example 3: Distinguishing NCGS from Fructan Sensitivity

Maria, 35, "gluten-sensitive":

• Went gluten-free 2 years ago, felt much better
• Never tested for celiac (went GF first—common mistake)
• Wants to know if she needs strict avoidance forever

Structured testing:

Week 1-2: Baseline (strict gluten-free)

• Symptoms: Minimal bloating (2/10)

Week 3: Gluten challenge (seitan, vital wheat gluten)

• Day 1: 50g seitan (pure gluten, low fructan)
• Day 2-3: Continue seitan
• Result: No increase in symptoms

Week 4: Washout (back to GF)

Week 5: Wheat challenge (whole wheat bread)

• Day 1: 2 slices whole wheat bread (gluten + fructans)
• Day 2-3: Continue wheat bread
• Result: Bloating (7/10), gas, mild cramping

Week 6: Fructan challenge (onions, garlic, no wheat)

• Day 1: Onion and garlic-heavy meal
• Day 2-3: Continue high-fructan foods
• Result: Bloating (8/10), gas

Conclusion: Fructan sensitivity, not gluten sensitivity

• Can tolerate: Sourdough (reduced fructans), small amounts of wheat
• Should avoid: Onions, garlic, high-fructan fruits
• Follows low-FODMAP approach instead of strict gluten-free

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🚀 Getting Started (click to expand)

Week 1-2: Discovery & Assessment Phase

Identify Your Reaction Type

Start by answering these key questions:

1. When do symptoms appear?

   • <30 minutes → likely IgE allergy (medical attention needed)
   • 30min-2 hours → likely intolerance (lactose, fructose)
   • 2-24 hours → sensitivity or delayed reaction
   • Variable timing → histamine intolerance (bucket theory)

2. What are your main symptoms?

   • Hives, swelling, breathing issues → allergy (see doctor immediately)
   • Bloating, gas, diarrhea → intolerance
   • Multi-system (GI + headache + skin) → histamine intolerance
   • Fatigue, brain fog, joint pain → sensitivity

3. Is it dose-dependent?

   • Any amount causes reaction → likely allergy
   • Small amounts OK, large amounts problematic → intolerance
   • Variable based on daily total → histamine bucket

Keep a Food & Symptom Diary

• Document everything you eat for 2 weeks
• Rate symptoms 1-10 for each category (GI, skin, energy, etc.)
• Note timing of symptoms relative to meals
• Look for patterns

Critical First Steps:

• If eating gluten with symptoms → test for celiac disease BEFORE eliminating
• If rapid reactions or breathing issues → see allergist immediately
• If dairy-related symptoms → distinguish allergy vs. intolerance (hives = allergy)
• Don't eliminate multiple foods at once—you won't know what helps

Week 3-4: Targeted Elimination Trial

Based on your symptom pattern, start with most likely trigger:

Option 1: Lactose Intolerance Trial

• Switch to lactose-free milk for 1 week
• Keep all other foods the same
• If 50%+ improvement → confirms lactose intolerance
• Find your threshold with gradual reintroduction

Option 2: Histamine Elimination Trial

• Eat only fresh foods for 2 weeks
• No leftovers past 24 hours
• Avoid aged, fermented, cured foods
• If 50%+ improvement → confirms histamine intolerance

Option 3: Gluten/Wheat Trial (after celiac testing)

• Strict gluten-free for 4 weeks
• Track symptom improvement
• Must reintroduce to confirm (symptoms return on rechallenge)
• Consider fructan hypothesis (try sourdough or seitan)

Option 4: Comprehensive Elimination Diet

• For complex cases with multiple suspected triggers
• See Elimination Diets for full protocol
• Work with dietitian for guidance

Week 5-8: Reintroduction & Confirmation

Critical step—don't skip!

Systematic reintroduction:

1. After symptoms improve, reintroduce suspected food
2. Eat normal serving for 3 days
3. Track symptoms carefully
4. If symptoms clearly return → confirms trigger
5. If no symptoms → that food is safe

Find your threshold:

• For intolerances: Test different amounts
• Most intolerances are dose-dependent
• Small amounts may be tolerable
• Don't eliminate more than necessary

Month 3+: Long-Term Management

Build Your Personal Food Plan

• Create "safe foods" list (no reaction)
• Create "threshold foods" list (OK in small amounts)
• Create "avoid foods" list (clear reactions)
• Understand your triggers fully

Optimize Your Approach

• Use enzyme supplements when helpful (lactase, DAO)
• Support gut health (may improve tolerance over time)
• Re-test tolerance every 6 months
• Don't over-restrict—quality of life matters

When to Get Professional Help

• Eliminating major food groups (nutrition risk)
• Multiple food reactions
• Child with food issues (growth/development concern)
• Suspected true allergy (anaphylaxis risk)
• Symptoms persist despite dietary changes
• Need help creating balanced meal plans

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🔧 Troubleshooting

Problem 1: "I react to so many foods—what do I do?"

Possible causes:

• Histamine intolerance (bucket theory—many foods are high-histamine)
• Gut dysfunction amplifying all reactions
• Multiple overlapping sensitivities
• Food anxiety creating perceived reactions
• Mast cell activation syndrome (MCAS)

Solutions:

• Start with histamine elimination (most common multi-food sensitivity)
• Address gut health as priority (gut dysfunction is often the root cause)
• Don't eliminate more foods—focus on healing
• See gastroenterologist to rule out SIBO, IBD, celiac
• Work with dietitian to ensure you're not over-restricting
• Consider whether anxiety about food is worsening symptoms
• If truly reacting to everything, see specialist for MCAS evaluation

Problem 2: "Elimination didn't help—now what?"

Possible causes:

• Wrong foods eliminated (not the actual triggers)
• Didn't eliminate long enough (need 4-6 weeks)
• Symptoms not food-related (stress, hormones, other medical issue)
• Hidden sources of trigger food still in diet
• Underlying condition needs treatment (not just diet)

Solutions:

• Review everything consumed (hidden sources in sauces, supplements, medications)
• Extend elimination to 6 weeks if only tried 2-3 weeks
• Try different elimination (if did gluten, try histamine next)
• See doctor to rule out non-food causes (IBD, IBS, SIBO, hormonal issues)
• Consider whether stress, sleep, or other lifestyle factors are primary drivers
• Some symptoms aren't food-related—don't assume everything is diet

Problem 3: "Food sensitivity tests say I'm reactive to 30+ foods"

Possible causes:

• IgG "food sensitivity" tests are not scientifically valid
• IgG measures exposure, not sensitivity
• These tests lead to unnecessary restriction

Solutions:

• Ignore IgG food sensitivity panel results (not endorsed by medical organizations)
• Save your money—don't purchase these tests ($200-600 wasted)
• Use systematic elimination diet instead (more accurate, free)
• Valid tests: IgE for allergies, tTG-IgA for celiac, breath tests for intolerances
• If you already paid for IgG test, don't eliminate all the "reactive" foods
• Start fresh with evidence-based approach

Problem 4: "Symptoms return even though I'm avoiding my trigger food"

Possible causes:

• Hidden sources of trigger (processed foods, cross-contamination)
• Different food is actually the trigger
• Symptoms not food-related
• For histamine: total load still too high (other sources)
• Underlying gut issue not addressed

Solutions:

• Read ALL labels carefully (allergens hide in unexpected places)
• Check for cross-contamination (shared equipment, utensils)
• For lactose: check medications and supplements (often contain lactose fillers)
• For gluten: verify "gluten-free" certification (not just "wheat-free")
• For histamine: track total daily load, not just one food
• Keep symptom diary to identify true pattern
• Consider gut health workup if symptoms persist

Problem 5: "I'm afraid to reintroduce foods"

Possible causes:

• Fear of symptoms returning
• Worried about "undoing progress"
• Food anxiety developing
• Misunderstanding that reintroduction is essential for diagnosis

Solutions:

• Understand: Reintroduction CONFIRMS what you're actually sensitive to
• Without reintroduction, you may be avoiding safe foods unnecessarily
• Symptoms returning during reintroduction is informative, not harmful
• It's a controlled test—if symptoms return, you have your answer
• Start with foods you're least concerned about
• Work with dietitian or therapist if food anxiety is developing
• Goal is dietary freedom, not maximum restriction

Problem 6: "Went gluten-free without testing—can I still test for celiac?"

Possible causes:

• Celiac testing requires gluten in diet
• Already gluten-free = unreliable test results
• Stuck with uncertainty

Solutions:

• Option 1: Gluten challenge (eat gluten for 6-8 weeks, then test)
  • Pro: Definitive diagnosis
  • Con: Symptoms may return; hard to tolerate
• Option 2: Genetic testing (HLA-DQ2/DQ8)
  • Can be done while gluten-free
  • Negative = celiac ruled out (99%+ certainty)
  • Positive = can't rule out celiac without gluten challenge
• Option 3: Accept uncertainty and continue gluten-free
• Best practice: Always test for celiac BEFORE going gluten-free

Problem 7: "Doctor dismisses my food sensitivity concerns"

Possible causes:

• Some doctors unfamiliar with food intolerances/sensitivities
• Skeptical of "food sensitivity" trend
• Focused on ruling out serious conditions first

Solutions:

• Request specific testing: celiac panel, IgE allergy testing, breath tests
• Ask for referral to allergist or gastroenterologist
• Bring detailed food/symptom diary as evidence
• Focus on objective symptoms (weight loss, anemia, clear patterns)
• Seek second opinion if dismissed without evaluation
• Find doctor experienced in food intolerances
• Sometimes GI symptoms ARE just IBS—proper workup rules out serious causes

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❓ Common Questions (click to expand)

Can you develop food allergies as an adult?

Yes. Adult-onset food allergies are increasingly common, especially shellfish, tree nuts, and fish allergies. The reasons aren't fully understood but may relate to environmental changes, gut health, and immune system shifts.

Will I outgrow my food allergy?

It depends on the allergen. Milk, egg, soy, and wheat allergies are often outgrown (50-80% by adolescence). Peanut, tree nut, fish, and shellfish allergies are more likely to be lifelong (though ~20% of peanut allergies are outgrown).

Are food sensitivity tests worth it?

• IgE tests for true allergies: Yes, when ordered by an allergist
• IgG "sensitivity" panels: No—not scientifically valid
• Celiac serology: Yes, accurate screening tool
• Hydrogen breath tests: Yes, for lactose/fructose malabsorption
• Elimination diets: Most accurate for intolerances and sensitivities

How do I know if it's an allergy or intolerance?

Allergy signs: Rapid onset (minutes), skin reactions (hives, swelling), respiratory symptoms (wheezing, throat tightness), can occur with tiny amounts.

Intolerance signs: Delayed onset (30 min to hours), primarily digestive symptoms (bloating, gas, diarrhea), dose-dependent (small amounts may be OK).

When in doubt, see an allergist—especially if you've had any respiratory symptoms or swelling.

✅ Quick Reference (click to expand)

Types of Food Reactions Summary

Type	Mechanism	Timing	Severity	Testing
IgE allergy	Immune (IgE)	Minutes to 2h	Can be fatal	Skin prick, IgE blood
Celiac	Autoimmune	Hours to days	Intestinal damage	tTG-IgA, biopsy
Intolerance	Enzyme deficiency	30min to hours	Uncomfortable	Breath test, elimination
Sensitivity	Unclear	Hours to days	Variable	Elimination only

When to See a Doctor

• Any suspected food allergy (especially respiratory symptoms)
• History of anaphylaxis
• Suspected celiac disease (test BEFORE eliminating gluten)
• Planning to eliminate major food groups
• Symptoms persist despite dietary changes
• Nutritional deficiencies developing

Red Flags Requiring Immediate Medical Attention

• Difficulty breathing or swallowing
• Swelling of tongue, lips, or throat
• Rapid pulse with dizziness
• Loss of consciousness
• Severe abdominal pain with vomiting

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💡 Key Takeaways

Essential Insights

• Not all food reactions are the same — Allergies, intolerances, and sensitivities differ in mechanism, severity, and management
• True food allergies are IgE-mediated and can be life-threatening — Require strict avoidance and emergency medication
• Intolerances are uncomfortable but not dangerous — Often dose-dependent; enzyme supplements may help
• IgG food sensitivity tests are not scientifically valid — Don't waste money; use systematic elimination instead
• Elimination diets are the gold standard — More accurate than most testing for identifying triggers
• Don't eliminate foods unnecessarily — Only avoid foods with clear, reproducible reactions
• Gut health influences food reactivity — Healing the gut may increase tolerance over time

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📚 Sources (click to expand)

Food Allergies:

• "Food allergy vs. intolerance" — Harvard Health (2020) —
• "Food allergy vs. intolerance" — Mayo Clinic —
• "IgE-mediated food allergy" — Lancet (2021) —
• "Early introduction of allergenic foods" — NEJM LEAP study (2015) —

Testing:

• "IgG food testing position statement" — AAAAI — — Not recommended
• "The myth of IgG food panel testing" — AAAAI —
• "Are Food Sensitivity Tests Accurate?" — Academy of Nutrition and Dietetics —

General:

• "The 8 Most Common Food Intolerances" — Healthline —
• "Food Intolerances" — PMC (2019) —

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🔗 Pages in This Section

• Common Intolerances — Lactose, fructose, histamine
• Gluten Sensitivity — NCGS, the fructan debate
• Elimination Diets — How to identify your triggers
• Food Chemical Sensitivities — Salicylates, oxalates, amines

🔗 Related Topics

• Digestive Issues — IBS, SIBO, celiac disease
• Gut Health — Microbiome and food reactivity
• Digestion & Absorption — How digestion works

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For Mo

Assessment Questions

When users report suspected food reactions, start with:

1. "What symptoms do you experience, and how soon after eating do they appear?"

   • <30 min → likely IgE allergy (medical attention needed)
   • 30min-2h → likely enzyme-based intolerance
   • 2-24h → sensitivity, NCGS, or food chemicals
   • Variable → histamine (bucket theory)

2. "Which foods seem to trigger reactions?"

   • Single food → targeted elimination
   • Multiple unrelated foods → consider histamine or gut issue
   • All dairy → distinguish lactose intolerance vs. milk allergy
   • Wheat/gluten → test for celiac FIRST, then consider NCGS/fructans

3. "Have you been tested for celiac disease or allergies?"

   • If eating gluten and symptomatic → celiac testing BEFORE elimination
   • If already GF without testing → can't rule out celiac
   • If respiratory symptoms with food → allergy testing needed

4. "Do symptoms vary in severity day-to-day, or are they consistent?"

   • Consistent → true allergy or enzyme deficiency
   • Variable → histamine bucket, total load, or stress-related

5. "How's your gut health overall?"

   • Recent antibiotics, SIBO, IBD → secondary intolerances likely
   • Good gut health → primary intolerance or allergy more likely

User Type Recommendations

Type 1: Suspected IgE Allergy (rapid onset, respiratory symptoms)

• Action: Immediate medical referral—do not suggest self-management
• Encourage allergist visit for skin prick test and specific IgE testing
• Discuss EpiPen and emergency action plan
• Never dismiss rapid reactions as "just intolerance"

Type 2: Clear Intolerance Pattern (consistent GI symptoms after specific food)

• Action: Targeted elimination trial
• Suggest enzyme supplements (lactase for dairy, DAO for histamine)
• Recommend breath tests for confirmation (lactose, fructose)
• Help find personal threshold—not all-or-nothing

Type 3: Complex/Multiple Sensitivities (reactions to many foods)

• Action: Start with histamine elimination (most common)
• Address gut health—may be root cause of multiple sensitivities
• Suggest working with dietitian for comprehensive elimination
• Avoid overwhelming with too much restriction at once

Type 4: Self-Diagnosed "Gluten Sensitivity" (no testing)

• Action: Test for celiac FIRST (if still eating gluten)
• Explain fructan hypothesis—may not be gluten at all
• Encourage structured reintroduction to confirm trigger
• Prevent unnecessary lifelong restriction

Type 5: Test-Obsessed (wants IgG panels, expensive tests)

• Action: Educate about IgG unreliability—save their money
• Explain elimination diet as gold standard (more accurate, free)
• Redirect to valid tests only (celiac serology, IgE for allergies, breath tests)

Common Mistakes to Avoid

1. Eliminating multiple foods at once without testing → Can't identify specific triggers
2. Skipping reintroduction phase → Unnecessary lifelong restriction
3. Assuming all reactions are allergies → Most are intolerances (dose-dependent, manageable)
4. Going gluten-free before celiac testing → Makes diagnosis impossible
5. Paying for IgG food sensitivity panels → Not scientifically valid
6. Restricting children's diets without medical guidance → Growth and nutrition risk
7. Ignoring gut health → Underlying dysfunction amplifies all sensitivities

Coaching Scenarios

Scenario 1: The Dairy Dilemma

User: "I think I'm allergic to dairy—I get bloated after ice cream."

Mo: "Let me help you distinguish between allergy and intolerance. Could you answer:

• Do you get hives, swelling, or breathing issues? (allergy signs)
• Or mainly bloating, gas, diarrhea? (intolerance signs)
• How soon after eating dairy do symptoms appear?

If it's bloating 1-2 hours later, that sounds like lactose intolerance rather than a true dairy allergy. Lactose intolerance is very common (65% of adults) and manageable:

Try this:

1. Switch to lactose-free milk for 2 weeks—same nutrition, no lactose
2. Note if symptoms improve
3. You may still tolerate hard aged cheese (very low lactose) and yogurt (probiotics help)
4. Lactase enzyme tablets before dairy meals

True milk allergies cause immune reactions and are less common in adults. If you've had any swelling, hives, or respiratory symptoms, see a doctor for IgE testing."

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Scenario 2: The Gluten Question

User: "I feel so much better since going gluten-free. Do I have celiac?"

Mo: "Feeling better without gluten is meaningful, but let's figure out WHY you feel better—it matters for how strict you need to be.

First, have you been tested for celiac disease?

• If no, and you're willing to eat gluten for 6-8 weeks, testing is worthwhile
• Celiac requires lifelong strict avoidance; other sensitivities may not

If celiac is ruled out, a few possibilities:

1. Fructan sensitivity — Recent research shows many 'gluten-sensitive' people actually react to fructans (a carbohydrate in wheat), not gluten itself
2. Non-celiac gluten sensitivity (NCGS) — Real but less common
3. General diet improvement — You may have reduced processed foods overall

To test the fructan hypothesis:

• Try sourdough bread (fermentation reduces fructans)—if tolerated, fructans were likely the issue
• Or test pure gluten (seitan) separately from wheat bread

This tells you whether you need strict gluten-free (celiac/NCGS) or just low-FODMAP (fructan sensitivity). Finding the real trigger prevents unnecessary restriction."

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Scenario 3: The Multi-Reactor

User: "I react to SO many foods—dairy, gluten, eggs, tomatoes, avocados, leftovers. Am I allergic to everything?"

Mo: "When you're reacting to many different foods, it often points to one of two things:

1. Histamine intolerance — Notice that aged cheese, leftovers, avocados, tomatoes are all high-histamine? This isn't multiple allergies; it's your body struggling to break down histamine (total load/"bucket" theory)

2. Gut dysfunction — A compromised gut makes you more reactive to everything. Healing the gut often reduces multiple sensitivities.

Let's start with histamine:

• For 2-3 weeks, eat ONLY fresh foods (no leftovers past 24h)
• Avoid: aged cheese, cured meats, fermented foods, alcohol, tomatoes, avocados
• Cook and eat fresh; freeze leftovers immediately
• Track symptoms

If you improve 50%+, histamine is likely the main issue. Then we address gut health to improve your tolerance long-term. You're not destined to avoid all these foods forever—we need to find and fix the root cause."

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Scenario 4: The Test Buyer

User: "I'm thinking about getting an IgG food sensitivity panel. They're expensive but I need answers."

Mo: "I'm going to save you $200-600 right now: IgG food sensitivity tests are not scientifically valid.

Why major allergy organizations don't recommend them:

• IgG antibodies indicate EXPOSURE, not sensitivity
• Elevated IgG is NORMAL after eating a food regularly
• May actually indicate tolerance, not intolerance
• No major medical organization endorses these tests (AAAAI, EAACI, etc.)

What DOES work (and costs nothing): A systematic elimination diet with reintroduction—this is the gold standard and more accurate than any test for intolerances and sensitivities.

Valid tests worth considering:

• Celiac serology (tTG-IgA) — if eating gluten
• IgE allergy tests — if you have rapid reactions
• Hydrogen breath tests — for lactose/fructose malabsorption

Want me to help you set up a proper elimination diet instead?"

Red Flags Requiring Medical Referral

• Any respiratory symptoms (wheezing, throat tightness, difficulty breathing)
• History of anaphylaxis
• Rapid onset reactions (<5 minutes)
• Unintentional weight loss or signs of malabsorption
• Blood in stool
• Severe symptoms in children
• Planning to eliminate multiple food groups (nutritional risk)
• Eating disorder history (restriction can trigger relapse)
• Pregnant/breastfeeding and planning major eliminations

Always say: "This sounds like something that needs medical evaluation. Please see [allergist/GI doctor/dietitian] to get proper testing and support."